Tube pancreaticogastrostomy: A novel approach for laparoscopic duodenum-preserving total pancreatic head resection

Laparoscopic duodenum-preserving pancreatic head resection avoids complicated organ resection and reconstruction. In recent years, it has replaced laparoscopic pancreaticoduodenectomy as the first choice for treating benign and low-grade pancreatic head tumors. During the operation, pancreaticojejunostomy (PJ) is performed, and a small amount of pancreatic head is retained to ensure blood supply. In this study, we innovatively apply modified pancreaticogastrostomy (PG) and remove the pancreatic head further to reduce the occurrence of pancreatic fistula and intraoperative trauma. Clinical data of 53 patients who received laparoscopic duodenum-preserving total pancreatic head resection in our hospital from May 2020 to December 2023 were retrospectively analyzed, including sex, age, operation time, and postoperative complications. According to the reconstruction mode of the residual pancreatic duct, the patients were classified into a modified PG group and a PJ group. There were 25 cases in the modified PG group and 28 in the PJ group. The operation was completed in all patients, with no conversion to laparotomy. The anastomotic time of modified PG was significantly shorter than that of PJ (15.4 ± 0.8 min vs 35.1 ± 4.8 min, P < .05), and the postoperative hospital stay in the modified PG group was also significantly shorter than that in the PJ group (10.1 ± 2.2 min vs 15.1 ± 9.1 min, P < .05). There was no significant difference in the overall incidence of postoperative pancreatic fistula (POPF) between the 2 groups, the rates being 10.7% and 8.0% in the PJ and modified PG groups, respectively. One patient underwent reoperation due to abdominal hemorrhage caused by POPF in the PJ group, and another patient in the modified PG group underwent reoperation due to postoperative gastric fistula. The study provides preliminary evidence of the safety and effectiveness of the modified PG method, leading to shorter gastrointestinal reconstruction and postoperative hospitalization time. However, it is essential to note the limitations of the small sample size and short-term follow-up. Future studies should expand the sample size and assess the long-term outcomes of this anastomosis method.